Emergency department overcrowding: Causes, impacts, and strategies for effective management
Keywords:
Emergency Department, Overcrowding, Exit Block, Boarding, Healthcare Management, Patient OutcomesAbstract
Background: Emergency department (ED) overcrowding arises from an imbalance between patient demand and hospital capacity, significantly affecting hospital systems and patient care. Overcrowding, characterized by a mismatch between healthcare demand and available resources, leads to delays in diagnostic processes and treatment initiation, negatively impacting patient outcomes and hospital efficiency. Aim: This narrative review aims to analyze the causes, impacts, and strategies for managing ED overcrowding. It seeks to provide a comprehensive understanding of the contributing factors and propose solutions to mitigate the issue effectively. Methods: The review employs a narrative analysis approach, examining the input–throughput–output model to understand the dynamics of ED overcrowding. It categorizes factors into input, throughput, and output, exploring their interconnections and influence on overcrowding. The review also assesses signs of overcrowding, including delays in treatment and the impact of exit block and boarding. Results: The analysis identifies key causes of overcrowding, such as limited hospital bed availability, exit block, and boarding. It highlights how these factors lead to extended waiting times, increased mortality rates, and reduced patient satisfaction. The review also examines the impact of the COVID-19 pandemic on overcrowding, emphasizing the role of output and throughput factors.
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Di Somma, S.; Paladino, L.; Vaughan, L.; Lalle, I.; Magrini, L.; Magnanti, M. Overcrowding in emergency department: An international issue. Intern Emerg. Med. 2015, 10, 171–175. DOI: https://doi.org/10.1007/s11739-014-1154-8
Salway, R.; Valenzuela, R.; Shoenberger, J.; Mallon, W.; Viccellio, A. Emergency Department (ED) overcrowding: Evidence-based answers to frequently asked questions. Rev. Méd. Clínica Las Condes 2017, 28, 213–219. DOI: https://doi.org/10.1016/j.rmclc.2017.04.008
Merodio, G., Ramis-Salas, M., Valero, D., & Aubert, A. (2020). How much is one life worth? The right to equity healthcare for improving older patients’ health infected by COVID-19. Sustainability, 12(17), 6848. DOI: https://doi.org/10.3390/su12176848
Pitts, S.R.; Pines, J.M.; Handrigan, M.T.; Kellermann, A.L. National trends in emergency department occupancy, 2001 to 2008: Effect of inpatient admissions versus emergency department practice intensity. Ann Emerg Med. 2012, 60, 679–686.e3. DOI: https://doi.org/10.1016/j.annemergmed.2012.05.014
Richardson, D.B.; Mountain, D. Myths versus facts in emergency department overcrowding and hospital access block. Med. J. Aust. 2009, 190, 369–374. DOI: https://doi.org/10.5694/j.1326-5377.2009.tb02451.x
Tulenko, K., & Vervoort, D. (2020). Cracks in the system: the effects of the coronavirus pandemic on public health systems. The American Review of Public Administration, 50(6-7), 455-466. DOI: https://doi.org/10.1177/0275074020941667
Emergency Medicine Practice Commitee, ACEP. Emergency Department Overcrowding: High Impact Solutions; ACEP: Irving, TX, USA, 2016.
Australasian College for Emergency. Medicine Position Statement; Australasian College for Emergency: Melbourne, Australia, 2019.
Australasian College for Emergency Medicine. P02 Policy on Standard Terminology; ACEM: Melbourne, Australia, 2014.
Solberg, L.I.; Asplin, B.R.; Weinick, R.M.; Magid, D.J. Emergency department crowding: Consensus development of potential measures. Ann. Emerg. Med. 2003, 42, 824–834. DOI: https://doi.org/10.1016/S0196-0644(03)00816-3
Pines, J.M. Emergency Department Crowding in California: A Silent Killer? Ann. Emerg. Med. 2013, 61, 612–614. DOI: https://doi.org/10.1016/j.annemergmed.2012.12.016
Ackroyd-Stolarz, S.; Guernsey, J.R.; MacKinnon, N.J.; Kovacs, G. The association between a prolonged stay in the emergency department and adverse events in older patients admitted to hospital: A retrospective cohort study. BMJ Qual. Saf. 2011, 20, 564–569. DOI: https://doi.org/10.1136/bmjqs.2009.034926
Hong, K.J.; Shin, S.D.; Song, K.J.; Cha, W.C.; Cho, J.S. Association between ED crowding and delay in resuscitation effort. Am. J. Emerg. Med. 2013, 31, 509–515. DOI: https://doi.org/10.1016/j.ajem.2012.09.029
Pines, J.M.; Pollack, C.V., Jr.; Diercks, D.B.; Chang, A.M.; Shofer, F.S.; Hollander, J. The Association Between Emergency Department Crowding and Adverse Cardiovascular Outcomes in Patients with Chest Pain. Acad. Emerg. Med. 2009, 16, 617–625. DOI: https://doi.org/10.1111/j.1553-2712.2009.00456.x
Pines, J.M.; Shofer, F.S.; Isserman, J.A.; Abbuhl, S.B.; Mills, A. The Effect of Emergency Department Crowding on Analgesia in Patients with Back Pain in Two Hospitals. Acad. Emerg. Med. 2010, 17, 276–283. DOI: https://doi.org/10.1111/j.1553-2712.2009.00676.x
van der Linden, M.C.; Meester, B.E.; van der Linden, N. Emergency department crowding affects triage processes. Int. Emerg. Nurs. Nov. 2016, 29, 27–31. DOI: https://doi.org/10.1016/j.ienj.2016.02.003
Fitzgerald, G.; Jelinek, G.A.; Scott, D.; Gerdtz, M.F. Emergency department triage revisited. Emerg. Med. J. 2010, 27, 86–92. DOI: https://doi.org/10.1136/emj.2009.077081
Göransson, K.E.; Ehrenberg, A.; Marklund, B.; Ehnfors, M. Emergency department triage: Is there a link between nurses’ personal characteristics and accuracy in triage decisions? Accid. Emerg. Nurs. 2006, 14, 83–88. DOI: https://doi.org/10.1016/j.aaen.2005.12.001
Carter, E.J.; Pouch, S.M.; Larson, E.L. The Relationship Between Emergency Department Crowding and Patient Outcomes: A Systematic Review. J. Nurs. Sch. 2014, 46, 106–115. DOI: https://doi.org/10.1111/jnu.12055
American College of Emergency Physicians (ACEP). Crowding. Policy statement. Ann Emerg Med. 2013, 61, 726–727.
Kenny, J.F.; Chang, B.C.; Hemmert, K.C. Factors Affecting Emergency Department Crowding. Emerg. Med. Clin. North Am. 2020, 38, 573–587. DOI: https://doi.org/10.1016/j.emc.2020.04.001
Rabin, E.; Kocher, K.; McClelland, M.; Pines, J.; Hwang, U.; Rathlev, N.; Asplin, B.; Trueger, N.S.; Weber, E. Solutions to Emergency Department ‘Boarding’ And Crowding Are Underused and May Need to Be Legislated. Health Aff. 2012, 31, 1757–1766. DOI: https://doi.org/10.1377/hlthaff.2011.0786
Office USGA. Hospital Emergency Departments: Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames. Available online: https://www.gao.gov/products/gao-09-347
Asplin, B.R.; Magid, D.J.; Rhodes, K.V.; Solberg, L.I.; Lurie, N.; Camargo, C.A., Jr. A conceptual model of emergency department crowding. Ann. Emerg. Med. 2003, 42, 173–180. DOI: https://doi.org/10.1067/mem.2003.302
Rathlev, N.K.; Chessare, J.; Olshaker, J.; Obendorfer, D.; Mehta, S.D.; Rothenhaus, T.; Crespo, S.; Magauran, B.; Davidson, K.; Shemin, R.; et al. Time Series Analysis of Variables Associated with Daily Mean Emergency Department Length of Stay. Ann. Emerg. Med. 2007, 49, 265–271. DOI: https://doi.org/10.1016/j.annemergmed.2006.11.007
Hoot, N.R.; Aronsky, D. Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions. Ann. Emerg. Med. 2008, 52, 126–136.e1. DOI: https://doi.org/10.1016/j.annemergmed.2008.03.014
Nagree, Y.; Ercleve, T.N.O.; Sprivulis, P.C. After-hours general practice clinics are unlikely to reduce low acuity patient attendances to metropolitan Perth emergency departments. Aust. Health Rev. 2004, 28, 285–291. [ DOI: https://doi.org/10.1071/AH040285
Dent, A.W.; Phillips, G.; Chenhall, A.J.; McGregor, L.R. The heaviest repeat users of an inner city emergency department are not general practice patients. Emerg. Med. 2003, 15, 322–329. DOI: https://doi.org/10.1046/j.1442-2026.2003.00470.x
Sprivulis, P. Estimation of the general practice workload of a metropolitan teaching hospital emergency department. Emerg. Med. 2003, 15, 32–37. DOI: https://doi.org/10.1046/j.1442-2026.2003.00405.x
Colineaux, H.; Pelissier, F.; Pourcel, L.; Lang, T.; Kelly-Irving, M.; Azema, O.; Charpentier, S.; Lamy, S. Why are people increasingly attending the emergency department? A study of the French healthcare system. Emerg. Med. J. 2019, 36, 548–553. DOI: https://doi.org/10.1136/emermed-2018-208333
Hwang, U.; McCarthy, M.L.; Aronsky, D.; Asplin, B.; Crane, P.W.; Craven, C.K.; Epstein, S.K.; Fee, C.; Handel, D.A.; Pines, J.M.; et al. Measures of Crowding in the Emergency Department: A Systematic Review. Acad. Emerg. Med. 2011, 18, 527–538. DOI: https://doi.org/10.1111/j.1553-2712.2011.01054.x
Institute of Medicine of the National Academies. Hospital-Based Emergency Care: At the Breaking Point; The National Academies Press: Washington, DC, USA, 2007; 424p, Available online: https://www.nap.edu/catalog/11621/hospital-based-emergency-care-at-the-breaking-point
Sayah, A.; Rogers, L.; Devarajan, K.; Kingsley-Rocker, L.; Lobon, L.F.; Minimizing, E.D. Waiting Times and Improving Patient Flow and Experience of Care. Emerg. Med. Int. 2014, 2014, 981472. DOI: https://doi.org/10.1155/2014/981472
Derose, S.F.; Gabayan, G.Z.; Chiu, V.Y.; Yiu, S.C.; Sun, B.C. Emergency Department Crowding Predicts Admission Length-of-Stay but Not Mortality in a Large Health System. Med. Care 2014, 52, 602–611. DOI: https://doi.org/10.1097/MLR.0000000000000141
Nippak, P.M.D.; Isaac, W.W.; Ikeda-Douglas, C.J.; Marion, A.M.; Vandenbroek, M. Is there a relation between emergency department and inpatient lengths of stay? Can. J. Rural Med. 2014, 19, 12–20.
Mason, S.; Knowles, E.; Boyle, A. Exit block in emergency departments: A rapid evidence review. Emerg. Med. J. 2016, 34, 46–51. DOI: https://doi.org/10.1136/emermed-2015-205201
Celenza, T.; Bharath, J.; Scop, J. Attitudes toward careers in emergency medicine. EMA Emerg. Med. Australas 2012, 24, 11 DOI: https://doi.org/10.1111/j.1742-6723.2012.01607.x
Jelinek, G.A.; Weiland, T.J.; Mackinlay, C. Supervision and feedback for junior medical staff in Australian emergency departments: Findings from the emergency medicine capacity assessment study. BMC Med. Educ. 2010, 10, 74. DOI: https://doi.org/10.1186/1472-6920-10-74
Fatovich, D.; Hirsch, R. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg. Med. J. 2003, 20, 406–409. DOI: https://doi.org/10.1136/emj.20.5.406
Forero, R.; Hillman, K. Access Block and Overcrowding: A Literature Review. Prepared for the Australasian College for Emergency Medicine; University of New South Wales: Liverpool, NSW, Australia, 2003.
Gilligan, P.; Winder, S.; Ramphul, N.; O'kelly, P. The Referral and Complete Evaluation Time Study. Eur. J. Emerg. Med. 2010, 17, 349–353. DOI: https://doi.org/10.1097/MEJ.0b013e328337b9f1
Richardson, D.; McMahon, K.L. Emergency department access block occupancy predicts delay to surgery in patients with fractured neck of femur. Emerg. Med. Australas 2009, 21, 304–308. DOI: https://doi.org/10.1111/j.1742-6723.2009.01201.x
Jelinek, G.; Mackinlay, C.; Weiland, T.; Hill, N.; Gerdtz, M. Barriers to the operation of mental health legislation in Australian emergency departments: A qualitative analysis. J. Law Med. 2011, 18, 716–723. [
Hossain, L.; Guan, D.C.K. Modelling coordination in hospital emergency departments through social network analysis. Disasters 2011, 36, 338–364. DOI: https://doi.org/10.1111/j.0361-3666.2010.01260.x
Ye, L.; Zhou, G.; He, X.; Shen, W.; Gan, J.; Zhang, M. Prolonged length of stay in the emergency department in high-acuity patients at a Chinese tertiary hospital. Emerg. Med. Australas 2012, 24, 634–640. DOI: https://doi.org/10.1111/j.1742-6723.2012.01588.x
Khanna, S.; Boyle, J.; Good, N.; Lind, J. Early discharge and its effect on ED length of stay and access block. Stud. Health Technol. Inform. 2012, 178, 92–98.
Richardson, D. Relationship between inpatient hospital bed occupancy and ED performance. EMA Emerg. Med. Australas 2011, 23, 35.
Martin, M.; Champion, R.; Kinsman, L.; Masman, K. Mapping patient flow in a regional Australian emergency department: A model driven approach. Int. Emerg. Nurs. 2011, 19, 75–85. DOI: https://doi.org/10.1016/j.ienj.2010.03.003
Definition of Boarded Patient. Available online: https://www.acep.org/patient-care/policy-statements/definition-of-boarded-patient/
CENA (College of Emergency Nursing Australasia). Emergency Department Overcrowding and Access Block; CENA Position Statement: Liverpool, Australia, 2018.
Kobayashi, Kimiyoshi J., Steven J. Knuesel, Benjamin A. White, Marjory A. Bravard, Yuchiao Chang, Joshua P. Metlay, Ali S. Raja, and Melissa Lp Mattison Md. "Impact on length of stay of a hospital medicine emergency department boarder service." Journal of hospital medicine 15, no. 3 (2020): 147-153. DOI: https://doi.org/10.12788/jhm.3337
Richardson, D. Access Block Point Prevalence Survey. Carried Out by the Road Trauma and Emergency Medicine Unit, Australian National University on behalf of the Australasian College for Emergency Medicine; ACEM: Melbourne, Australia, 2009.
Plunkett, P.K.; Byrne, D.G.; Breslin, T.; Bennett, K.; Silke, B. Increasing wait times predict increasing mortality for emergency medical admissions. Eur. J. Emerg. Med. 2011, 18, 192–196. DOI: https://doi.org/10.1097/MEJ.0b013e328344917e
Gilligan, P.; Winder, S.; O’Kelly, P. The reduce (reducing emergency department utilisation and crowding efforts) study. Acad. Emerg. Med. 2012, 19, 756.
Carr, B.G.; Hollander, J.E.; Baxt, W.G.; Datner, E.M.; Pines, J.M. Trends in Boarding of Admitted Patients in US Emergency Departments 2003–2005. J. Emerg. Med. 2010, 39, 506–511. DOI: https://doi.org/10.1016/j.jemermed.2008.04.035
Forero, R.; McCarthy, S.; Hillman, K. Access block and emergency department overcrowding. Crit. Care 2011, 15, 216. DOI: https://doi.org/10.1186/cc9998
Sklar, D.P.; Handel, D.A.; Hoekstra, J.; Baren, J.M.; Zink, B.; Hedges, J.R. The Future of Emergency Medicine: An Evolutionary Perspective. Acad. Med. 2010, 85, 490–495. DOI: https://doi.org/10.1097/ACM.0b013e3181ccb628
Braitberg, G. Emergency department overcrowding: Dying to get in? Med. J. Aust. 2007, 187, 624–625. DOI: https://doi.org/10.5694/j.1326-5377.2007.tb01448.x
Forero, R.; Hillman, K.M.; McCarthy, S.; Fatovich, D.M.; Joseph, A.P.; Richardson, D.B. Access block and ED overcrowding. Emerg. Med. Australas 2010, 22, 119–135. DOI: https://doi.org/10.1111/j.1742-6723.2010.01270.x
Walters, E.H.; Dawson, D.J. Whole-of-hospital response to admission access block: The need for a clinical revolution. Med. J. Aust. 2009, 191, 561–563. DOI: https://doi.org/10.5694/j.1326-5377.2009.tb03312.x
Scott, I.; Vaughan, L.; Bell, D. Effectiveness of acute medical units in hospitals: A systematic review. Int. J. Qual. Health Care 2009, 21, 397–407. DOI: https://doi.org/10.1093/intqhc/mzp045
Cha, W.C.; Shin, S.D.; Cho, J.S.; Song, K.J.; Singer, A.J.; Kwak, Y.H. The Association Between Crowding and Mortality in Admitted Pediatric Patients from Mixed Adult-Pediatric Emergency Departments in Korea. Pediatr. Emerg. Care 2011, 27, 1136–1141. DOI: https://doi.org/10.1097/PEC.0b013e31823ab90b
Guttmann, A.; Schull, M.J.; Vermeulen, M.J.; Stukel, T.A. Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada. BMJ 2011, 342, d2983. DOI: https://doi.org/10.1136/bmj.d2983
Richardson, D.B. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med. J. Aust. 2006, 184, 213–216. DOI: https://doi.org/10.5694/j.1326-5377.2006.tb00204.x
Polevoi, S.K.; Quinn, J.V.; Kramer, N.R. Factors associated with patients who leave without being seen. Acad. Emerg. Med. 2005, 12, 232–236. DOI: https://doi.org/10.1111/j.1553-2712.2005.tb00874.x
Weiss, S.J.; Ernst, A.A.; Derlet, R.; King, R.; Bair, A.; Nick, T.G. Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. Am. J. Emerg. Med. 2005, 23, 288–294. DOI: https://doi.org/10.1016/j.ajem.2005.02.034
Vieth, T.L.; Rhodes, K.V. The effect of crowding on access and quality in an academic ED. Am. J. Emerg. Med. 2006, 24, 787–794. DOI: https://doi.org/10.1016/j.ajem.2006.03.026
Asaro, P.V.; Lewis, L.M.; Boxerman, S.B. Emergency department overcrowding: Analysis of the factors of renege rate. Acad. Emerg. Med. 2007, 14, 157–162. DOI: https://doi.org/10.1111/j.1553-2712.2007.tb01760.x
Kulstad, E.B.; Hart, K.M.; Waghchoure, S. Occupancy Rates and Emergency Department Work Index Scores Correlate with Leaving Without Being Seen. West. J. Emerg. Med. 2010, 11, 324–328.
Schull, M.J.; Vermeulen, M.; Slaughter, G.; Morrison, L.; Daly, P. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann. Emerg. Med. 2004, 44, 577–585. DOI: https://doi.org/10.1016/j.annemergmed.2004.05.004
Hwang, U.; Richardson, L.D.; Sonuyi, T.O.; Morrison, R.S. The Effect of Emergency Department Crowding on the Management of Pain in Older Adults with Hip Fracture. J. Am. Geriatr. Soc. 2006, 54, 270–275. DOI: https://doi.org/10.1111/j.1532-5415.2005.00587.x
McCarthy, M.L.; Zeger, S.L.; Ding, R.; Levin, S.R.; Desmond, J.S.; Lee, J.; Aronsky, D. Crowding Delays Treatment and Lengthens Emergency Department Length of Stay, Even Among High-Acuity Patients. Ann. Emerg. Med. 2009, 54, 492–503.e4. DOI: https://doi.org/10.1016/j.annemergmed.2009.03.006
Jeanmonod, D.; Jeanmonod, R. Overcrowding in the emergency department and patient safety. Vignettes Patient Saf. 2018, 2, 257. Available online: http://www.intechopen.com/books/vignettes-in-patient-safety-volume-2/overcrowding-in-the-emergency-department-and-patient-safety DOI: https://doi.org/10.5772/intechopen.69243
Pines, J.M.; Garson, C.; Baxt, W.G.; Rhodes, K.V.; Shofer, F.S.; Hollander, J.E. ED crowding is associated with variable perceptions of care compromise. Acad. Emerg. Med. 2007, 14, 1176–1181. DOI: https://doi.org/10.1111/j.1553-2712.2007.tb02340.x
Pines, J.M.; Iyer, S.; Disbot, M.; Hollander, J.; Shofer, F.S.; Datner, E.M. The Effect of Emergency Department Crowding on Patient Satisfaction for Admitted Patients. Acad. Emerg. Med. 2008, 15, 825–831. DOI: https://doi.org/10.1111/j.1553-2712.2008.00200.x
Australasian College for Emergency Medicine. ACEM Workforce Sustainability Survey Report; ACEM Australasian College for Emergency Medicine: Melbourne, Australia, 2016.
Australian Medical Association. Position Statement on Quality and Safety in Public Hospitals; Australian Medical Association: Kingston, ACT, Australia, 2006.
Mumma, B.E.; McCue, J.Y.; Li, C.-S.; Holmes, J.F. Effects of Emergency Department Expansion on Emergency Department Patient Flow. Acad. Emerg. Med. 2014, 21, 504–509. DOI: https://doi.org/10.1111/acem.12366
Shepperd, S.; Iliffe, S.; Doll, H.A.; Clarke, M.; Kalra, L.; Wilson, A.D.; Bradley, D.G. Admission avoidance hospital at home. Cochrane Database Syst. Rev. 2016, 9, CD007491. DOI: https://doi.org/10.1002/14651858.CD007491.pub2
Lee, I.-H.; Chen, C.-T.; Lee, Y.-T.; Hsu, Y.-S.; Lu, C.-L.; Huang, H.-H.; Hsu, T.-F.; How, C.-K.; Yen, D.H.-T.; Yang, U.-C. A new strategy for emergency department crowding: High-turnover utility bed intervention. J. Chin. Med. Assoc. 2017, 80, 297–302. DOI: https://doi.org/10.1016/j.jcma.2016.11.002
Savioli, G.; Ceresa, I.F.; Maggioni, P.; Lava, M.; Ricevuti, G.; Manzoni, F.; Oddone, E.; Bressan, M.A. Impact of ED Organization with a Holding Area and a Dedicated Team on the Adherence to International Guidelines for Patients with Acute Pulmonary Embolism: Experience of an Emergency Department Organized in Areas of Intensity of Care. Medicines 2020, 7, 60. DOI: https://doi.org/10.3390/medicines7100060
Savioli, G.; Ceresa, I.F.; Manzoni, F.; Ricevuti, G.; Bressan, M.A.; Oddone, E. Role of a Brief Intensive Observation Area with a Dedicated Team of Doctors in the Management of Acute Heart Failure Patients: A Retrospective Observational Study. Medicines 2020, 56, 251. DOI: https://doi.org/10.3390/medicina56050251
Savioli, G.; Ceresa, I.F.; Luzzi, S.; Gragnaniello, C.; Lucifero, A.G.; Del Maestro, M.; Marasco, S.; Manzoni, F.; Ciceri, L.; Gelfi, E.; et al. Rates of Intracranial Hemorrhage in Mild Head Trauma Patients Presenting to Emergency Department and Their Management: A Comparison of Direct Oral Anticoagulant Drugs with Vitamin K Antagonists. Medicina 2020, 56, 308. DOI: https://doi.org/10.3390/medicina56060308
Ceresa, I.F.; Savioli, G.; Angeli, V.; Novelli, V.; Muzzi, A.; Grugnetti, G.; Cobianchi, L.; Manzoni, F.; Klersy, C.; Lago, P.; et al. Preparing for the Maximum Emergency with a Simulation: A Table-Top Test to Evaluate Bed Surge Capacity and Staff Compliance with Training. Open Access Emerg. Med. 2020, 12, 377–387. DOI: https://doi.org/10.2147/OAEM.S267069
Fiorelli, Elisa M., Viviana Bozzano, Mattia Bonzi, Silvia V. Rossi, Giorgio Colombo, Gaia Radici, Tiberio Canini et al. "Incremental risk of intracranial hemorrhage after mild traumatic brain injury in patients on antiplatelet therapy: systematic review and meta-analysis." The Journal of Emergency Medicine 59, no. 6 (2020): 843-855. DOI: https://doi.org/10.1016/j.jemermed.2020.07.036
Piccini, Gaia Bavestrello, J. Cavenaile, and M. A. Bressan. "Wounds at risk of tetanus: unexpected level of underimmunization in a patient cohort." (2020). DOI: https://doi.org/10.21203/rs.2.20169/v4
Savioli, Gabriele, Iride Francesca Ceresa, Luca Ciceri, Fabio Sciutti, Mirko Belliato, Giorgio Antonio Iotti, Sabino Luzzi et al. "Mild head trauma in elderly patients: Experience of an emergency department." Heliyon 6, no. 7 (2020). DOI: https://doi.org/10.1016/j.heliyon.2020.e04226
Savioli, G.; Ceresa, I.F.; Macedonio, S.; Gerosa, S.; Belliato, M.; Iotti, G.A.; Luzzi, S.; Del Maestro, M.; Mezzini, G.; Lucifero, A.G.; et al. Trauma Coagulopathy and Its Outcomes. Medicines 2020, 56, 205. DOI: https://doi.org/10.3390/medicina56040205
Pandian, Jeyaraj D., Yogeshwar Kalkonde, Ivy Anne Sebastian, Cynthia Felix, Gerard Urimubenshi, and Jackie Bosch. "Stroke systems of care in low-income and middle-income countries: challenges and opportunities." The Lancet 396, no. 10260 (2020): 1443-1451. DOI: https://doi.org/10.1016/S0140-6736(20)31374-X
Alsabri, M.; Boudi, Z.; Lauque, D.; Dias, R.D.; Whelan, J.S.; Östlundh, L.; Alinier, G.; Onyeji, C.; Michel, P.; Liu, S.W.; et al. Impact of Teamwork and Communication Training Interventions on Safety Culture and Patient Safety in Emergency Departments: A Systematic Review. J. Patient Saf. 2020, 18, e351–e361. DOI: https://doi.org/10.1097/PTS.0000000000000782
Alsabri, M.; Boudi, Z.; Zoubeidi, T.; Alfaki, I.A.; Levy, P.; Oneyji, C.; Shan, L.; Camargo, C.A.; Michel, P.; Tazarourte, K.; et al. Analysis of Risk Factors for Patient Safety Events Occurring in the Emergency Department. J. Patient Saf. 2020, 18, e124–e135. DOI: https://doi.org/10.1097/PTS.0000000000000715
Boudi, Z.; Lauque, D.; Alsabri, M.; Östlundh, L.; Oneyji, C.; Khalemsky, A.; Rial, C.L.; Liu, S.W.; Camargo, C., Jr.; Aburawi, E.; et al. Association between boarding in the emergency department and in-hospital mortality: A systematic review. PLoS ONE 2020, 15, e0231253. DOI: https://doi.org/10.1371/journal.pone.0231253
Haroutunian, P.; Alsabri, M.; Kerdiles, F.J.; Adel Ahmed Abdullah, H.; Bellou, A. Analysis of Factors and Medical Errors Involved in Patient Complaints in a European Emergency Department. Adv. J. Emerg. Med. 2017, 2, e4.
Al-Kuwaiti, A.; Hefny, A.F.; Bellou, A.; Eid, H.O.; Abu-Zidan, F.M. Epidemiology of head injury in the United Arab Emirates. Turk. J. Trauma Emerg. Surg. 2012, 18, 213–218. DOI: https://doi.org/10.5505/tjtes.2012.03710
Lovett, P.B.; Illg, M.L.; Sweeney, B.E. A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System. Am. J. Med. Qual. 2016, 31, 246–255. DOI: https://doi.org/10.1177/1062860614564618
Pollaris, G.; Sabbe, M. Reverse triage: More than just another method. Eur. J. Emerg. Med. 2016, 23, 240–247. DOI: https://doi.org/10.1097/MEJ.0000000000000339
Chang, A.M.; Cohen, D.J.; Lin, A.; Augustine, J.; Handel, D.A.; Howell, E.; Kim, H.; Pines, J.M.; Schuur, J.D.; McConnell, K.J.; et al. Hospital Strategies for Reducing Emergency Department Crowding: A Mixed-Methods Study. Ann. Emerg. Med. 2018, 71, 497–505.e4. DOI: https://doi.org/10.1016/j.annemergmed.2017.07.022
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